Do we need a third medical school in New Zealand?

In October 2016 it was announced that Waikato University had put in a bid for a new medical school. The proposal has been met with mixed reactions, as the two existing medical schools believe it would cause a lot of stress and difficulty to add extra numbers of medical students to a system that hasn’t planned for them. Conversely, the proposal is backed by the Waikato District Health Board, which feels the addition of another medical school in the central North Island would combat the unfortunate lack of GPs in the area – especially rurally.

The new medical school would be based both at Waikato University and at 12-15 regional sites in the surrounding Mid-North area. The school would service a similar number of students per year to the existing schools in Auckland and Dunedin; it would take 60 students for every year of the program, 240 in total, which would mean a significant increase in graduates across the country.

Waikato University also proposes that their new school’s degree would only take four years to complete rather than five, and it aims to have 60% of graduates returning to rural communities and the primary health sector to train and work as GPs. This idea is based on one that operates in Northern Ontario, Canada, with a lot of success. The new medical school also plans to heavily focus on Maori and Pacific student numbers coming through the doors, wanting them to reflect the general population.

In theory, this seems logical. In practice, it raises several issues. According to statistics put out by the current medical schools there is a projected 43% growth in new medical students by 2020, up 170 students from the 400 admitted in 2008. This is without the proposed Waikato school adding to those numbers. In its current state, the system these two schools run under is set up to cater for the continuing growth in students – also allowing for those who join overseas workforces rather than finding jobs in New Zealand.

It’s true that there is a shortage of GPs in the country, but Waikato University’s proposal seems to neglect the fact that this shortage is already being addressed by Auckland and Otago. Along with the increased numbers of graduates from both existing medical schools, there is strategic funding supplied by Health Workforce NZ that has been giving GP numbers in New Zealand a needed boost. The GPEP 1 training program has been seeing a jump in the number of placements every year since 2013, and this suggests continued growth.

Continued growth is one of the major concerns that arise from this proposal. There is already potential for there to be an over-supply of doctors in NZ through 2030 based on projected numbers of working graduates in the next two decades, fewer numbers of graduates leaving to Australia and instead choosing to work here, as well as an expected increase of NZ trainees from Australian medical schools returning. The risk of unemployed doctors means there is a corresponding risk that the Government funding that helps train the doctors has been wasted.

In comparison to international statistics, New Zealand is not that far behind countries like the UK when it comes to the medical workforce. In NZ there are 1.9 doctors to every 1000 people compared to the UK’s 2.7, and the ratio of medical students per 10,000 population is 0.9 while the UK sits only slightly above that at 1.0.

However, one very different result is that while the UK only has a 25% expected growth in students, NZ is expected to top 50% if all of the places are funded.

This statistic is obviously demonstrated here in the packed graduate pipeline, which is already experiencing difficulties trying to place students as their numbers expand. This bottleneck is especially noticeable in the Auckland medical program, and it will only grow. Adding the Waikato school will put more pressure on Auckland, as it requires the support of the Waikato DHB and regional hospitals to find placements for many of its students. Taking that support away – which the new school will do, as the proposal wishes to target the Mid-North – is going to mean dispersing Auckland students. They could be left with nowhere to go, or if they are placed, there’s concern that the placement may not meet the requirements to produce an experienced enough doctor at the end of it. DHBs are already having to create jobs for current graduates in the pipeline, what will happen if the new school pushes yet more primary health-focused graduates into it?

Waikato University believes that by putting forth these targets they’re addressing the issue of an aging population, as well as the projection that 40% of registered GPs will retire in the next 10 years. However, given the existing schools’ own projections for graduates in the future, not to mention the current bottleneck for clinical training spots, that void looks like it is already on track to being filled by that time. Rather than Waikato fixing the issue, it seems more like it will just disrupt the progress that Auckland and Otago are already making.

There is also the proposal’s intended focus on Maori and Pacific Island students. There is an implication here that a large pool of these historically-underrepresented ethnicities are being left untapped or not catered to. In truth, Auckland and Otago have spent 20 years trying to build appropriate infrastructure for Maori and Pacific students to succeed, so the suggestion that there isn’t as much opportunity for them to get medical training doesn’t follow. In fact, the existing scheme has led to over 90% of Maori students graduating out of both the Auckland and Otago programmes, with evidence that they are more likely to focus on the primary health sector.

Similarly, the rural dilemma the new medical school proposes to fix by luring graduates to outlying communities may not have its intended effect. It’s true that places like Tokoroa, Huntly and Taumarunui are lacking in local doctors, but that’s as much due to the student placement bottleneck as it is graduates looking for different opportunities. Also, much like the Maori and Pacific Island admissions scheme, Auckland and Otago already have a fully-implemented rural and regional admissions scheme (RRaS) that takes students coming from a rural background and helps them to return back to those communities upon graduating. Evidence from a 2016 NZ Medical Journal study shows that this scheme has been effective in encouraging students into the rural sector, and also lines up with similar international findings.

One other issue concerns the staff for the medical school itself. There is already a shortage of qualified academic staff in all relevant medical fields, and it’s unclear what adding a new school will do to those numbers. It’s likely that since Waikato doesn’t have a strong foundation in the medical sciences, they would have trouble attracting academic staff to give students the required level of training in fields like biomedical science and several of the biology sectors. It adds to the concern that displacement of Auckland students does – that their teaching will result in insufficient training for their fields and we will be left with graduating doctors who are underqualified and not ready to join the workforce.

The medical workforce in New Zealand is a national issue, as the health of everyone in the country relies on a strong system of doctors and other medical professionals. However, given our relatively small population and the efforts of the two existing medical schools in Auckland and Otago, it seems there is not enough evidence that a third medical school is necessary to fix the issues its proposal underlines.